Singap Med J
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There are limitations to the sensitivity and specificity of conventional two-dimensional echocardiograms in making an accurate diagnosis in certain patient populations. This led to the development of specific contrast-enhancing agents with the following characteristics: small enough to cross the pulmonary capillary bed, remain stable throughout the length of the procedure, do not dissolve in blood, and rapidly cleared from the body with low toxicity. ⋯ The low take-up rate among clinicians can largely be attributed to the black box warning by the United States Food and Drug Administration in 2007, after the coincidental occurrence of four patient deaths and about 190 severe cardiopulmonary reactions shortly after contrast agent administration. In this article, we address the clinical safety of contrast agents, share our institution's experience in using it and elaborate on the clinical indications of contrast echocardiography.
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Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. ⋯ A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.
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Comparative Study
Prevalence of metabolic syndrome in patients with psoriasis: a cross-sectional study in Singapore.
Psoriasis is a chronic inflammatory condition that affects the skin and joints, and is associated with cardiovascular risk factors, including metabolic syndrome (MetS). We aimed to assess the prevalence of MetS in patients with psoriasis and determine whether there was a correlation between psoriasis severity and MetS in a Singapore population. ⋯ The prevalence of MetS in patients with psoriasis in Singapore was 45.1%, or nearly threefold higher than the Singapore general population. Patients with psoriasis should be screened yearly for MetS and any modifiable cardiovascular risk factors should be actively controlled.